Atlantic Health · 1 day ago
Utilization Reviewer (RN)- Full Time Days, 8 AM - 4 PM, Morristown
Morristown, NJ
Full-time
Onsite
Mid Level
$48/hr - $84/hrAtlantic Health is a leading non-profit health care system in the nation, and they are seeking a Utilization Reviewer (RN) to provide clinical information to insurance companies to secure payer authorizations. The role involves daily surveillance of observation cases, proactive intervention to avoid denials, and coordination with interdisciplinary teams regarding patient discharge plans.
FitnessHealth CareHospitalMedical
Responsibilities
Provides timely and thorough clinical information to insurance companies and other intermediaries to secure payer authorizations and avoid denials or reduction in level of care
Performs daily surveillance of observation cases and works with PA discussing any barriers to progression of care or discharge
Intervenes proactively to avoid denials or delays in authorization
Actively communicates information to other CM team members and interdisciplinary teams regarding progress or payer issues related to continued hospitalization and post-acute service associated with the patients discharge plan
Refers cases and issues to Physician Advisors or Designees in compliance with department procedures with timely follow up as indicated
Assists in identification and collection of avoidable days
Coordinates with the CM RN and/or CMA to identify and complete the process for CMS required patient notices
Completes and documents utilization reviews, physician advisor referrals and other communications related to assigned cases in accordance with department policy and procedure
Complies with the Condition of Code 44 process, CMS required patient notices and other regulatory requirements within the utilization management process
Maintains proficiency in the application of organization selected clinical review criteria sets evidenced through IRR testing
Qualification
Required
Graduate of an accredited school of nursing
Current RN license
Preferred
BSN
Case Management
Benefits
Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full-time and part-time team members)
Life & AD&D Insurance.
Short-Term and Long-Term Disability (with options to supplement)
403(b) Retirement Plan: Employer match, additional non-elective contribution
PTO & Paid Sick Leave
Tuition Assistance, Advancement & Academic Advising
Parental, Adoption, Surrogacy Leave
Backup and On-Site Childcare
Well-Being Rewards
Employee Assistance Program (EAP)
Fertility Benefits, Healthy Pregnancy Program
Flexible Spending & Commuter Accounts
Pet, Home & Auto, Identity Theft and Legal Insurance
Company
Atlantic Health
Atlantic Health is at the forefront of medicine, setting standards for quality health care in New Jersey, Pennsylvania and the New York metropolitan area.
Founded in 1996
10001+ employees
H1B Sponsorship
Atlantic Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (14)
2024 (15)
2023 (10)
2022 (11)
2021 (10)
2020 (5)
Funding
Current Stage
Late StageLeadership Team
Saad Ehtisham
President & CEO
C
Colleen McManus
Executive Director, System Operations
Recent News
2025-12-04
2025-11-12
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